Since its relatively new beginning in 1967, beginning with the first heart transplant performed by Dr. Christian Bernard in Capetown, South Africa, the field or organ transplantation has slipped from media attention, becoming common place in our world. Although out of mind, transplantation has not ceased to be an invaluable for of saving and prolonging lives. In 1996, the most recent year for which statistics are available, approximately 518,000 organ transplantations have been performed. The actual breakdown is as follows; 450,000 bone grafts; 44,000 cornea transplants; 11,800 kidney transplants; 4,000 liver transplants; 2,000 heart transplants; 5,500 skin grafts.

In examining the reasons for concern, I’ve posed the following questions.

1. Why is there a shortage of organs being donated for transplantation?
2. What are some of the objections to donation?
3. What is being done to increase donations in the United States and specifically in New York State?

A good number of people are reluctant to donate due to the fear that they cannot have an open casket funeral. Donation of organs does not disfigure one’s body. You may still have an open casket funeral if it is so desired. Of course, this is dependent on one’s method of death, but is not contingent on someone donating an organ.

Many people hold the false belief that their families will have to pay the cost of the operation for the removal of the organ. This again is a fallacy. The total cost of the operation to procure the organ is paid for by the Organ Procurement Organization (OPO’s). OPO’s are the people who contact the families to ask for the donations. Assuming that the organs are donated, the OPO’s pass the information onto the United Network for Organ Sharing (UNOS). It is the UNOS who make up the waiting list and see that the organs are distributed fairly and equitably. Incidentally, to get onto the waiting list, one must be in severe need. In the case of liver transplantation for example, one’s condition must be acute and chronic. This means in simple terms, one must be on the cusp of death.

In 1968 the United States passed the Uniform Anatomical Gifts Act, which contains the directive that the family of a declared donor may not revoke the donor’s wish to donate their organ. Although this is clearly written into the act, the hospitals will not remove the organ, out of respect to the wishes of the family. This poses one of the largest problems in procurement of organs.

Basically, it means that if you wish to donate an organ, even though you have either filled out a "gift of life" card, or signed the back of your driver’s license stating your wish to donate an organ, your family may revoke you consent. The United States Health and Welfare department estimates that 15,000 organs a year are lost due to this revocation. The best way to be reasonably certain that your wishes are carried out is to tell your family now, that you wish to donate an organ. Perhaps if the families know that you feel strongly about the matter, they will respect your wishes.

Along these same lines, another major problem in procurement of organs for transplantation is the lack of signed pledge cards. Pledge cars may be acquired at any hospital or by calling and requesting one from your local UNOS. You may also pledge a donation by signing the back of your driver’s license.

Two other factors in the low rate of donation are lack of awareness for the need of organs, and the dislike of discussing you death. It is only through education that we may pass the word for the need of donations. Although it is a difficult subject for some, we must discuss or wishes at the event of our death if we feel the altruistic motivation for the donation of our organs.

In Hawaii, the worst state in the union for organ donation, in 1987 only 12 to 15 people donated organs. In that same year, there was a need for approximately 200 organs, in that state. The Hawaiian legislators pass an act which allows the state to place a surcharge of $1 on each driver’s license issued to go to a fund which educates people with the facts of organ donation. They also reaffirmed the Uniform Anatomical Gift Act of 1968, disallowing the families of the deceased to revoke the authorization for a donation.

In New York State, a large amount of money has been earmarked for the education of organ donation. One may hear a radio commercial calling for donations, see a sign on the side of a bus, or often see an ad in the local newspaper or in their favorite magazine. Often a guest speaker gives a presentation from an OPO educating the public on the need for donations.

New York State has passed a Proxy Law, which in itself allows for the appointment of an individual chosen by the writer of the proxy, to make medical decisions for the writer in the event the writer can no longer make the decisions for himself. What is seen relative to organ donation is the last decree of the law. It states that the writer of the proxy may designate organs to be donated in the event of his death. This is an important step in bring the need for donations into view of the public.

Upon a recent trip to my local hospital’s emergency room I was given a patient’s bill of rights in booklet form. Contained in the bill of rights is the right to donate organs. Again, this is a step to make the public aware of the need for organs. Both the patient’s bill of rights and the proxy law are important in the event the patient enters a persistent vegetative state (PVS). In PVS the patient can no longer make his wishes known, and it is the proxy or family who are laid with the burden of expressing the wishes of the patient. According to The Lancet (November 1997), they pose the idea that if one is in PVS for a period of one year or longer, it may be assumed that the person will not recover from the coma. They suggest that a law be passed allowing for the removal of needed organs for donation after a patient is in PVS for the one-year period. It is estimated that there are 25,000 adults and 10,000 children in PVS currently.

If allowed, the use of PVS patient’s organs would almost close the gap between persons in need of organs and the supply of the same. What the American Neurological Association suggests, is the need for a new definition of the meaning of "death". If the PVS patient is allowed to die in natural course, the organs often are not useful. In allowing for natural death, the person dies due to the death of bodily cells, from a lack of oxygen, making the organs useless. If it were allowable to remove the organs while the person is still supplying oxygen to their cells, many more organs would be available for donation. Although the use of zenotransplanted organs and body tissues is being used, it is too small a part of the whole problem in procurement of tissue and organs. Perhaps in the future, as technology progresses it will become a viable resource, but for now, we must rely on donations to help those in need.

QUESTIONS POSED

1. How long can an organ be stored prior to transplantation? Organs may only be stored for a maximum of 3 days, currently. Tissue (corneas, skin) may be stored for up to a week. Kidneys and livers cannot be stored. They must be transplanted immediately.
2. How can we increase donations? Suggestions include asking for donations on the federal income tax forms, much like the solicitation of money for wildlife funds. It was suggested to tie a wish to donate with one’s social security number. Another suggestion is to write the wish to donate on one’s HMO card. Still another suggestion is to make the wish to donate assumed, unless the back of one’s driver’s license is signed expressing a wish NOT to donate.

WHAT WENT WELL

• The handouts seemed to generate interest in donating
• The proxy law seemed to raise some interest
• Class participation was favorable, questions were raised, comments given

• Use of the blackboard for important terms
• Ask questions during the presentation
• Ask for comments during the presentation
• Stand up and walk around the classroom
• Incorporate the use of a video from a OPO

• The need for donations
• The process of obtaining donations
• OPO’s and UNOS
• Problems in procuring organs for transplantation
• Objections to donation
• Alternatives for human organs
• The need for educating the public
• Organ rejection, medical information